Using Mobile Application Strategies to Increase HPV Vaccination Rates among YMSM Project Summary Human papillomavirus (HPV) infection is a significant public health issue for young men who have sex with men (YMSM). The overall prevalence of HPV for men is approximately 40 to 50%. Rates of infection for men who have sex with men (MSM) are greater at 64% and above 90% for MSM who also are infected with HIV. HPV is associated with anal, penile and oropharyngeal cancers in men. Rates of anogenital HPV infection and cancers are highest among YMSM, with related costly morbidity and mortality. Available HPV vaccines have been found to be up to 100% effective at preventing infection with the primary oncogenic HPV types and the two types that cause about 90% of genital warts (6 and 11). The HPV vaccine first became available for males in 2009. In October, 2011 it was approved for prevention of anal cancers and pre-cancers. The Advisory Committee on Immunization Practices has identified YMSM (thru age 26) as an important population for HPV vaccination. However, rates of HPV vaccination initiation and 3-dose completion among men, especially YMSM, remain unacceptably low, and there is a dearth of studies examining factors related to vaccination or novel approaches to promote vaccine uptake among YMSM. We know that YMSM are technologically savvy and heavily utilize internet and mobile application technologies to obtain information about sexual health and seek out sexual partners. The community of YMSM who utilize mobile social network technologies for seeking social/ sexual interactions (estimated 6 million nationally) is dramatically on the rise. Therefore, we propose to recruit from this mobile MSM social network for promotion of a study specific Mobile Health (mHealth) Tool designed to enhance health communication and access to care. The study will be guided by the theories of Implementation Intention (IIT) and Planned Behavior (TPB). Thus, the aim of this research is to develop and employ an innovative approach to increase HPV vaccination among YMSM (ages 18-26); potentially identifying an inexpensive approach to reach a significantly under-immunized population of at-risk young men and help them connect to local health resources in order to protect themselves and prevent HPV associated cancers and diseases. Aim 1 is focused on development of the mHealth Tool. This tool (guided by IIT) will help to bridge the ?intention-behavior gap? by enabling concrete action plans designed to foster vaccine initiation. It will: 1) provide the linkage to a local health center, 2) enable vaccine scheduling/ reminders, 3) address known general barriers previously explicated in research (knowledge/ awareness, cost, access, recommendation), and 3) communicate other preferred health or health center information. Aim 2 determines if the use of mobile MSM social network recruitment, mobile survey, and a mHealth Tool is associated with HPV vaccine initiation. The mobile survey (guided by TPB) will also address the gap in research by identifying factors that are associated with vaccine intention as well as initiation. Aim 3 will evaluate the mHealth Tool with a goal to refine it for future mHealth research as a theoretically driven and sustainable/scalable model for vaccine promotion.